Michigan Court of Appeals; Docket No. 92840; Published
Judges Gillis, Weaver, and Allen; Unanimous
Official Michigan Reporter Citation: 169 Mich App 182; Link to Opinion 
STATUTORY INDEXING:
Allowable Expenses: Reasonable Necessity Requirement [§3107(1)(a)]
12% Interest Penalty on Overdue Benefits – Nature and Scope [§3142(2), (3)]
Requirement That Benefits Were Unreasonably Delayed or Denied [§3148(1)]
Bona Fide Factual Uncertainty / Statutory Construction Defense [§3148]
TOPICAL INDEXING:
Collateral Source Rule (MCL 600.6303)
Evidentiary Issues
CASE SUMMARY:
In a significant Opinion by Judge Weaver regarding an issue of first impression, the court unanimously held that defendant's contention that plaintiff’s medical care was not "reasonably necessary" is not a valid defense to an action for payment of medical benefits under the statute. The court expressed its holding as follows:
"Reasonableness of medical expenses cannot be used as a defense to liability in a no-fault accident case. Strong policy considerations support this position, since an accident victim would be held to an impossible standard of medical knowledge if required to determine that his or her doctor's orders were- 'reasonably necessary' before accepting treatment. Therefore, the defense of reasonableness as to plaintiff’s medical expenses was legally insufficient, — so untenable that no factual development would have prevented plaintiff’s right to recovery — and the trial court properly granted summary disposition pursuant to MCR 2.116(C)(9). . . . As there was no issue of liability, there were no genuine issues of material fact except as to the amount of damages, and the question of reasonableness went not to the issue of liability but to the issue of damages."
The court also ruled that evidence showing plaintiff’s medical bills had been paid by Blue Cross/Blue Shield was inadmissible and violative of the collateral source rule because plaintiff’s no-fault policy was uncoordinated. The court stated, "plaintiff’s contract with defendant did not contain a coordinated benefits clause. Plaintiff undoubtedly paid a higher premium for full benefits and defendant was accordingly required to pay full payment for those injuries covered by the policy, regardless of any payment received from additional policies."
The court also held that plaintiff was entitled to 12% interest pursuant to §3142 in light of the fact that plaintiff had submitted reasonable proof of the fact and the amount of the loss and defendant refused to pay the bills.
Although the court refused to award attorney fees on the basis that "a bona fide factual uncertainty precludes the characterization of defendant's conduct as unreasonable refusal or unreasonable delay warranting the imposition of attorney fees," the court did affirm the previous principle that failure to pay within the 30 day statutory period "gives rise to a rebuttal presumption of unreasonable refusal or unreasonable delay" See, Braley v DAIIE, 130 Mich App 34 (1983).
